Background/Purpose:

The objective of this analysis was to evaluate the extent to which frequency of gouty arthritis attacks is associated with disease progression and health care resource utilization.

Methods:

226 primary care physicians and rheumatologists who treated >=50 gouty arthritis patients in the last year were asked to complete a cross-sectional, retrospective chart review for patients with gouty arthritis. Patients were stratified by number of gouty arthritis attacks in the last year (<3 and >=3). Multivariate regression analysis was conducted to assess health-related outcomes during a 12-month observation period, to evaluate demographic and clinical characteristics, as well as to identify factors associated with attacks that resulted in an ER visit, urgent care utilization, or hospitalization. Variables included gouty arthritis severity, serum uric acid (sUA) level, prescription use, age, gender, duration of disease, presence of tophi, organ/joint damage, and comorbidities. SAS version 9.1 was used to conduct analyses.

Results:

1,039 gouty arthritis patients were identified for the analysis. 39.1% of patients were 5064 yrs of age and 81.9% were male. Time since diagnosis was 52.5±67.0 (mean±SD) months. The most frequently reported comorbidities were hypertension (51.2%), hyperlipidemia (37.9%), obesity (26.4%), osteoarthritis (22.9%), and diabetes (20.1%). 19.8% of patients had cardiovascular disease, while 16.9% of patients had chronic kidney disease. 14% of the patient population had organ/joint damage, and 17% had tophi at the most recent visit. Nearly 74% of patients were prescribed uric acid lowering therapy at the time of the survey. NSAIDs (46.0%), steroids (44.4%), and colchicine (32.1%) were therapies most commonly used for treatment of attacks. Patients in the >=3 attacks group (n = 195) were more likely to have physician-reported alcohol use (21% vs 10.8%, p<0.001), chronic kidney disease (25.6% vs 14.5%, p<0.001), obesity (32.3% vs 25%, p=0.040), and organ/joint damage (18.5% vs. 13%, p=0.056) compared to the <3 attacks group (n=844). sUA levels were 8.4±2.4 mg/dL in the >=3 attacks group and 7.0±2.1 mg/dL in the <3 attacks group. Patients with >=3 attacks were more likely to be seen primarily by rheumatologists (58% vs. 47.9%, p=0.011) and be reported as having severe gouty arthritis (24.1% vs. 12.0%, p<0.0001). These patients were also nearly twice as likely to use narcotics for treatment of gouty arthritis attacks compared with patients who had <3 attacks (22.6% vs. 12.3%, p=0.001). In the multivariate regression analysis, gouty arthritis attack frequency was the strongest predictor of having an ER visit (OR=4.00, 95% CI 2.566.25), urgent care visit (OR=5.59, 95% CI 2.3713.19), or hospitalization (OR=2.59, 95% CI 1.803.72), p<0.05 in all cases.

Conclusion:

Patients with >=3 gouty arthritis attacks were more likely to have attacks result in ER visits, urgent care center visits, and overnight hospitalizations, compared with the <3 attacks group. Greater attack frequency was also associated with alcohol use, CKD, obesity, organ/joint damage, increased gouty arthritis severity, higher prevalence of tophi, and use of narcotics.